药物降压治疗预防脑卒中后病人卒中的发生:脑卒中后降压治疗临床试验的初步结果

Preventive Effect of Antihypertensive Drug Treatment on Stroke in Patients with A History of Cerebrovascular Diseases:Preliminary Results of Post-Stroke Antihypertensive Treatment Study

  • 摘要: 脑卒中后降压治疗临床试验(PATS)是一项随机、双盲、安慰剂对照的大样本多中心临床试验研究,旨在探讨降压治疗是否降低脑卒中或一过性脑缺血发作(TIA)后的高血压或正常血压患者脑卒中及其他并发症的再发生与死亡率,采用密封信封系统将5665例符合入选条件的病人随机分为吲哒帕胺治疗组(2841例,吲哒帕胺2.5mg,l/d)和安慰剂对照组(2824例,安慰剂每日1片)。平均收缩压为154mmHg(80~280mmHg);平均舒张压为93mmHg(50~150mmHg)。平均年龄60岁,其中女性占28%,71%为缺血性脑卒中。平均随访时间近2年。3年随访期间,安慰剂组平均收缩压为149mmHg,吲哒帕胺治疗组为144mmHg,两组平均舒张压分别为89和87mmHg。安慰剂组致死性与非致死性脑卒中的3年初次发生率为12.3%,吲哒帕胺组为9.4%,相对危险度为0.71(P=0.0009)。全病因死亡的相对危险度为0.91(NS)。本试验的初步结果显示:给予脑卒中和TIA后病人吲哒帕胺2.5mgl/d,使血压下降5/2mmHg,可使致死性与非致死性脑卒中发生的危险降低29%,3年的绝对受益为减少29/1000脑卒中事件。

     

    Abstract: The Post-stroke Antihypertensive Treatment Study(PATS)was a randomized, double-blind and placebo-controlled clinical trial.It was aiming to determine whether antihypertensive treatment could reduce the risk of fatal and nonfatal stroke incidence in patients with a history of stroke or transient ischemic attack(TIA).5665 patients were randomized 2841 to indapamide treatment, took 2.5mg indapamide per day; 2824 to placebo,took one tablet of placebo with a sealed enveclope system.Systolic blood pressure ranged from 80 to 280mmHg and diastolic blood pressure from 50 to 150mmHg.The average systolic blood pressure was 154mmHg;average diastolic blood pressure,93mmHg.The mean age was 60 years,28% were women,71% were reported that the latest strokes were ischemic.Average follow-up approximated to 2 years.The three-year average systolic blood pressure was 149mmHg for the placebo group and 144mmHg for the indapamide treatment group,and the three-year diastolic blood pressure was 89mmHg and 87mmHg,respectively.The theee-year first incidence of fatal and nonfatal stroke was 12.3% for placebo treatment and 9.4% for indapamide.The relative risk by proportional hazards regression analysis was 0.71(P=0.O009).For deaths from all causes,the relative risk was O.91.The findings of this trial indicate that in patients with a history of stroke or TIA,blood pressure reduction of 5/2 mmHg with 2.5mg indapamide reduced the first incidence of fatal and nonfatal stroke by 29%,with three-year absolute benefit of 29 events per 1000 participants.

     

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